Ultracaine D-C forte, 40 mg+0.01 mg/ml 2 ml 10 pcs

Pharmacodynamics

Ultracaine D-C forte is a local anesthetic for infiltration and conduction anesthesia in dental practice. It has a fast action (latency period of 1 to 3 minutes). The duration of anesthesia is at least 75 minutes.

Owing to the low content of epinephrine in the drug, its effect on the cardiovascular system is expressed insignificantly: there is almost no increase in blood pressure and increase in heart rate.

Pharmacokinetics

The binding to plasma proteins of articaine is 95%. After injection into the oral submucosa, the half-life is on average 25 minutes. The drug penetrates the placental barrier to a minimal extent and is practically not excreted with the breast milk.

Articaine is excreted from the body mainly through the kidneys.

Indications

Infiltration and conduction anesthesia in dentistry (including in patients with concomitant severe somatic diseases):

Surgical interventions on mucosa and bone requiring ischemia; dental pulp surgery (extractions and extirpations); removal of periodontally diseased and decayed teeth (osteotomy) long term surgical procedures such as Caldwell-Luke, percutaneous osteosynthesis, removal of cysts, gingival work, root resection, cavity work and preparation of highly sensitive teeth for prosthetics.

Active ingredient

Composition

1 ml of solution for injection contains:

acting substances:

articaine hydrochloride – 40 mg and epinephrine hydrochloride – 0.012 mg;

auxiliary substances:

Sodium metabisulfite – 0.5 mg,

Sodium chloride – 1 mg,

water for injection

How to take, the dosage

In uncomplicated upper jaw dental extractions in the absence of inflammation, 1.7 ml of Ultracaine D-C (per tooth) is usually injected into the submucosa in the area of the vestibular transition fold.

In rare cases, an additional 1 ml to 1.7 ml is required to achieve complete anesthesia. The painful palatal injection can be dispensed with in most cases.

Anesthesia for palatal incisions and sutures to create a palatal depot requires approximately 0.1 ml of anesthetic per injection. When several adjacent teeth are extracted, the number of injections can usually be limited.

In the case of mandibular premolars without inflammation, mandibular anesthesia can be dispensed with, since the infiltration anesthesia provided by an injection of 1.7 ml per tooth is usually sufficient. If the desired effect is not achieved in this way, an additional injection of 1-1.7 ml of anesthetic into the submucosa in the area of the transition fold of the lower jaw on the vestibular side should be made. If even in this case it was not possible to achieve complete anesthesia, it is necessary to perform a blockade of the mandibular nerve.

In surgical interventions Ultracaine D-S is dosed individually depending on the severity and duration of the intervention. When performing a single therapeutic procedure in adults, up to 7 mg of Ultracaine (articaine) per 1 kg of body weight may be administered. It has been noted that patients tolerated doses up to 500 mg (corresponding to 7 cylindrical ampoules) well.

Intravenous use is contraindicated!

Do not inject into an inflamed area!

Interaction

The effects of blood pressure-increasing vasoconstrictors such as adrenomimetics, such as epinephrine, can be enhanced by tricyclic antidepressants or MAO inhibitors.

Similar observations have been described for concentrations of norepinephrine 1:25000 and epinephrine 1:80000 as vasoconstrictors.

The concentration of epinephrine in Ultracaine D-C is much lower at 1:200000. However, it is necessary to consider the possibility of such enhancement of action.

Special Instructions

In order to avoid intravascular injection, it is fundamentally necessary to perform an aspiration test, for which the Uniject K/Uniject K vario injection syringes are particularly suitable when using cartridges.

The injection pressure must match the sensitivity of the tissue.

In order to prevent infections (including hepatitis), care must be taken to always use new sterile syringes and needles each time a solution is drawn from vials or ampoules. Opened cartridges must not be used again for other patients!

Damaged cartridges must not be used for injections. Maximum safety from glass damage and perfect functioning is ensured by the use of accessories such as syringe holders (infiltration anesthesia: Uniject K or Uniject K vario; intraligamentary anesthesia: Ultraject).

It is not possible to eat until sensitivity returns.

Contraindications

Hypersensitivity to articaine, epinephrine or any other component of the drug.
Since the drug contains epinephrine, it is contraindicated in the following cases:

Do not use in patients with bronchial asthma with hypersensitivity to sulfites.

Side effects

Depending on the dosage, central nervous system disorders may occur: blurred consciousness up to its loss, respiratory disorders up to life-threatening arrest, muscle tremors and twitching of muscles up to generalized convulsions, nausea, vomiting. A drop in blood pressure and cardiac arrest may also occur during drug administration.

Allergic reactions may appear: in the form of swelling or inflammation in the injection site, hyperemia of the skin, itching, conjunctivitis, rhinitis, facial swelling (Quincke’s edema) with swelling of the upper and/or lower lip, swelling of the vocal cords with a coma feeling in the throat and difficulty in swallowing, urticaria, breathing difficulties up to anaphylactic shock. Headache often occurs.

Other side effects due to epinephrine – tachycardia, heart rhythm disturbances, increased blood pressure – are rare at a low concentration of 1:200000 (0.5 mg/100 ml).

Inadvertent intravascular injection may occasionally produce areas of ischemia up to and including tissue necrosis at the injection site.

Because of the sodium disulfite content, hypersensitivity reactions may occasionally occur in bronchial asthma patients, manifesting as vomiting, diarrhea, rapid breathing, acute asthma attack, impaired consciousness or shock.

Overdose

The treatment is symptomatic.

In case of the first signs of adverse effects or intoxication, such as nausea, motor restlessness, confusion during injection, it should be interrupted, the patient should be transferred to a horizontal position, the airway should be cleared, and the pulse and blood pressure should be monitored. It is recommended, even if symptoms do not seem to be too pronounced, to provide intravenous access.

In case of respiratory disturbances, depending on the severity, give oxygen, in some cases perform artificial respiration. Central analeptics are contraindicated. Muscle twitches or generalized convulsions are relieved by intravenous injection of barbiturates of short or ultra-short duration.

Decline in blood pressure and tachycardia or bradycardia are often relieved by placing the patient in a horizontal position. In severe circulatory disorders and shock of any genesis after discontinuation of the injection, emergency measures are indicated: ensuring airway patency (oxygen insufflation), intravenous infusion of fluids (electrolyte solution), glucocorticosteroids. Additionally, plasma substitutes, albumin may be administered.
In threatening circulatory disorders and increasing bradycardia, 0.25 ml to 1 ml of epinephrine is administered. Intravenous injection of epinephrine should be done slowly under control of pulse rate and blood pressure.

The single dose of intravenous injection of epinephrine should not exceed 0.1 mg, subsequently, if necessary, epinephrine can be administered by drip (the rate of infusion through the dropper is adjusted depending on the pulse rate and blood pressure).

Severe forms of tachycardia and tachyarrhythmia can be managed with antiarrhythmic drugs, but non-selective beta-adrenoblockers should not be used. Oxygenation and blood flow control are essential in all cases. Peripheral vasodilators should be used if necessary in patients with hypertension.

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